Individual
KELLY SUE JEFFERS-GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
400 OVESEN DR, WILTON, IA 52778-9612
(563) 732-4317
(563) 732-4318
Mailing address
850 43RD AVE STE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01527
IA
225XP0200X
Pediatric Occupational Therapist
01527
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0665711
—
IA
01
—
38037
BLUE CROSS BLUE SHIELD
IA
01
—
I15598
MEDICARE
IA
Enumeration date
08/22/2006
Last updated
03/29/2018
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